The etiology, diagnosis and therapy of esophageal perforations due to foreign bodies are discussed on the basis of a case and a literature survey. Eighty percent of the esophageal perforations are iatrogenic. Pain is the first symptom. When appearing after manipulation of the esophagus, a perforation should be ruled out by means of radiology. This should be done by soft tissues radiography of the neck, barium study of the esophagus and chest radiography. The early prevention of contamination and administration of antibiotics are important conditions of a successful conservative therapy.